Extradigital Glomus Tumor with Atypical Neuritis Presentation

Abstract

Glomus tumors are rare tumors of the arteriovenous junction that play a role in temperature regulation. They are most commonly found in the subungual finger. We present the case of a 77-year-old female with a chief complaint of a painful mass in her ulnar wrist. The differential diagnosis at the time was broad. Following a detailed history and physical exam, the etiology was believed to be that of a peripheral nerve sheath tumor. The patient was taken to the operating room for resection and biopsy of the mass. Histological evaluation confirmed that the mass was a glomus tumor. Our patient’s symptoms had completely resolved and functional status had improved to baseline by the time of her two-week postoperative clinic visit. This case report demonstrates the many complexities in the diagnosis of a glomus tumor and the important role of surgical treatment in obtaining relief from extradigital glomus tumors.

Extradigital Glomus Tumor Mimics an Intrinsic Nerve Tumor in a Trauma Patient: Case Report and Literature Review

“…It is frequently mentioned in the literature that MRI is the imaging modality of choice for the diagnosis of glomus tumors. However, in this case and other case reports, it misdiagnosed the tumor but localized the tumor size and anatomy for curative surgical excision [9,11,12]. Color Doppler USG is another imaging modality often reported in the literature that can aid in the diagnosis and pre-operative localization of glomus tumors [12,15,17].…”

“…This translates to prolonged duration of chronic excruciating pain or psychiatric diagnosis for patients in many cases especially if the tumor size is so small that it can't be easily palpated [1]. The pain described by patients is often disparate from the observed tumor size [3,9]. For this case presentation, the clinical suspicion was peripheral neuropathy from a traumatic neuroma based on the patient's history of a deep laceration in the exact location as the tumor, the MRI findings, and the radiating dysesthesias to the first three digits.…”

“…Only histopathological analysis often aided by immunohistochemistry is used to make a definite diagnosis of glomus tumor although a high clinical suspicion is necessary for it to be considered in the differential diagnosis [7,9]. It is frequently mentioned in the literature that MRI is the imaging modality of choice for the diagnosis of glomus tumors.…”

“…Additionally, USG doesn't require intravenous administration of contrast agents or radiation [15]. It is important to note that hypervascularity may not be reliable for detecting all glomus tumors since only two out of the three known histologic variants are highly vascular -glomangioma type with prominent vasculature, and glomangiomyoma type with prominent vasculature and smooth muscle [9,13]. The last histologic variant is solid glomus tumor type with poor vasculature and smooth muscle.…”

Tumor doloroso violáceo. Parte 2

“…No obstante, hasta en un 10% de los casos podría evidenciarse lesiones múltiples, las cuales pueden subdividirse en las variantes regional, tipo placa y diseminada (5) . Habitualmente se ubican a nivel subungueal, aunque algunas referencias concluyen que solo el 86% de los tumores glómicos extraungueales presentan dolor y sensibilidad localizada, así como solo el 2% presenta sensibilidad al frío, lo que lleva a un planteamiento diagnóstico inicial de tan solo el 9% (1,3,8) . Su diagnóstico de este tipo de tumor doloroso se basa en la sospecha clínica y debido a la presencia de varias fibras nerviosas al interior del TG, pueden presentarse ciertos signos semiológicos que pueden ayudar con su diagnóstico (Tabla 1).…”